System and method for creating and displaying optional order sets in healthcare environment

ABSTRACT

A method, system and computerized medium in a computerized environment for placing optional orders for an order set for a patient is provided. A request to display an order set for a patient is received. The order set comprises one or more optional orders. The optional orders that may or may not be placed for the order set. The optional orders are determined and the optional orders are displayed. A selection of one or more of the optional orders to be placed for the order set is received and the selected optional orders are placed for the order set.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of priority to U.S. ProvisionalApplication Ser. No. 60/722,481 filed on Sep. 30, 2005 and is acontinuation of U.S. patent application Ser. No. 11/537,924, filed Oct.2, 2006, and entitled “System and Method for Creating and DisplayingOptional Order Sets in Healthcare Environment,” which is herebyincorporated, in its entirety, by reference.

STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT

Not applicable.

BACKGROUND

A healthcare order in a clinical information system represents a requestby a caregiver for an action related to the patient. The action may beat the initiation of a diagnostic test, the administration ofmedication, or any other of a variety of other healthcare activities.Orders are captured by a clinical information system in a variety ofways including direct user entry through a computerized provider orderentry (CPOE) or indirect entry by an intermediary, for example a verbalor written request received from a doctor and entered by a user of thesystem, or by receiving an order from an interface from anotherinformation system. Orders may be placed singly or as a group of orders.A single order may include ordering an individual medication orlaboratory test for a patient, while an order set includes multipleorders for a patient. An exemplary order set is a Chem 20 laboratorytest, which includes a panel of discrete tests that are ordered througha single ordering action.

Often, when performing primary clinical processes, there are limitedsubsets of related orders that may be appropriate under certaincircumstances. In existing systems, a user is required to either placeall possible orders for an order set and then cancel any orders laterdeemed unnecessary due to the circumstances, or to place each orderindividually at one or more points in time. However, these approachesare time consuming and interrupt a caregiver's workflow. It would bebeneficial to have a system and method associate a set of appropriateorders in a manner that permits a user to easily select only thoseneeded in a specific instance.

SUMMARY

One embodiment of the present invention relates to a method in acomputerized environment for displaying optional healthcare orders. Ahealthcare order set for a patient is accessed. The order set includes afirst optional order and a second optional order, where the first andsecond optional orders may or may not be selected to be placed. Thefirst optional order is displayed before the order set has been placed.A request to place the order set is received and the second optionalorder is displayed after the order set has been placed.

In another embodiment, a method in a computerized environment forplacing optional orders for an order set for a patient is shown. Arequest to display an order set for a patient is received. The order setcomprises one or more optional orders. The optional orders that may ormay not be placed for the order set are determined and the optionalorders are displayed. A selection of one or more of the optional ordersto be placed for the order set is received and the selected optionalorders are placed for the order set.

In yet another embodiment, a computerized system for displaying optionalhealthcare orders is provided. The system comprises an accessingcomponent for accessing a healthcare order set for a patient. The orderset comprises a first optional order and a second optional order, wherethe first and second optional orders may or may not be selected to beplaced. The system further comprises a first displaying component fordisplaying the first optional order before the order set has been placedand a receiving component for receiving a request to place the orderset. The system comprises a second displaying component for displayingthe second optional order after the order set has been placed.

In still another embodiment of the present invention, a system in acomputerized environment for placing optional orders for an order setfor a patient is provided. The system comprises a first receivingcomponent for receiving a request to display an order set for a patient.The order set comprises one or more optional orders. The system furthercomprises a determining component for determining the optional ordersthat may be placed for the order set and a displaying component fordisplaying the optional orders to be selected to be placed. The systemincludes a second receiving component for receiving a selection of oneor more of the optional orders to be placed for the order set and anordering component for placing the selected optional orders for theorder set.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS

The present invention is described in detail below with reference to theattached drawing figures, wherein:

FIG. 1 is a block diagram illustrating a system for use in accordancewith an embodiment of the invention;

FIG. 2 is a flow diagram illustrating a method for configuring andstoring designations of possible healthcare orders in order sets inaccordance with an embodiment of the present invention;

FIG. 3 is a flow diagram illustrating a method for receiving theselection of optional orders from an order set to be placed from a firstuser in accordance with an embodiment of the present invention;

FIG. 4 is a flow diagram illustrating a method for receiving theselected optional orders to be placed by a second user in accordancewith an embodiment of the present invention;

FIG. 5 is a diagram illustrating orders in an optional order setdisplayed to a first and second user in accordance with an embodiment ofthe present invention;

FIG. 6 is a screen displaying how an order within an order set beingdefined and built as an optional in accordance with an embodiment of thepresent invention in order to be displayed to a second used after theorder set has been placed;

FIG. 7 is a screen displaying how an order within an order set may bedefined and built as optional order to be displayed to all users inaccordance with an embodiment of the present invention;

FIG. 8 is screen displaying how an order within an order set may bedefined and built as being required for the order set in accordance withan embodiment of the present invention;

FIG. 9 is a screen displaying how optional orders may be activated whenan order set is ordered in accordance with an embodiment of the presentinvention;

FIG. 10 is a screen displaying how an optional order may be activatedafter an order set has been placed in accordance with an embodiment ofthe present invention; and

FIG. 11 is a screen displaying an optional order after it has beenactivated in accordance with an embodiment of the present invention.

DETAILED DESCRIPTION

In one embodiment of the present invention, optional healthcare ordersare associated with a set of healthcare orders. The optional orders maybe activated when the order set is placed, allowing them to haveinformation captured in a computerized healthcare information system forthe order. Optional orders may be activated at a variety of times;including when the order set is first placed or subsequently based onclinical information determined during the workflow. Optional ordersallow for the flexibility of placing only those orders which areinitially requested without having to cancel orders that are not needed,or building a different set of orders for every possible combination oforders that could be requested throughout the process.

An order in a clinical information system represents a request by aclinician for an action related to the patient. The action can be theinitiation of a diagnostic test, the administration of a medication anyof a number of other actions or tasks. Orders are captured by clinicalinformation systems by a variety of means—direct user entry(Computerized Provider Order Entry (CPOE)), indirect entry by anintermediary, for example a verbal or written request that is conveyedto a nurse, lab technologist or pharmacist; or by an interface fromanother information system.

Orders can be placed singly or as a set. An example of a single orderwould be ordering an individual medication or a serology test, while anorder set includes multiple orders. An exemplary order set is a Chem 20,in which a number of discrete laboratory tests are ordered through asingle action. Placing an order in the system has a variety ofimplications, including its formal presence in the clinical workflow andthe triggering of other billing-related and clinical events.

In one embodiment of the invention, an order within a set of orders canbe designated as optional. Unlike conventional orders, optional ordersare not placed in the system by default when the set of orders isplaced. An optional order can be activated at the time the order set isplaced or later in the clinical process. If the user is ordering a setof orders associated with optional orders, the user is prompted toactivate the optional orders. Optional orders that are selected areactivated and added to the set of orders. Optional orders that are notactivated when ordering the order set are displayed with the set ofplaced orders, allowing the optional orders to be activated later, ifnecessary. A technologist or other user can activate optional ordersbased on the findings associated with other orders in the case, allowingfor flexibility of the testing path. In another embodiment, the abilityis provided to designate whether the activation of the order can occurat order time or only after the set of orders have been placed.

With reference to FIG. 1, an exemplary medical information system forimplementing the invention includes a general purpose-computing devicein the form of server 22. Components of server 22 may include, but arenot limited to, a processing unit, internal system memory, and asuitable system bus for coupling various system components, includingdatabase cluster 24 to the control server 22. The system bus may be anyof several types of bus structures, including a memory bus or memorycontroller, a peripheral bus, and a local bus using any of a variety ofbus architectures. By way of example, and not limitation, sucharchitectures include Industry Standard Architecture (ISA) bus, MicroChannel Architecture (MCA) bus, Enhanced ISA (EISA) bus, VideoElectronic Standards Association (VESA) local bus, and PeripheralComponent Interconnect (PCI) bus, also known as Mezzanine bus.

Server 22 typically includes therein or has access to a variety ofcomputer readable media, for instance, database cluster 24. Computerreadable media can be any available media that can be accessed by server22, and includes both volatile and nonvolatile media, removable andnon-removable media. By way of example, and not limitation, computerreadable media may comprise computer storage media and communicationmedia. Computer storage media includes both volatile and nonvolatile,removable and non-removable media implemented in any method ortechnology for storage of information, such as computer readableinstructions, data structures, program modules or other data. Computerstorage media includes, but is not limited to, RAM, ROM, EEPROM, flashmemory or other memory technology, CD-ROM, digital versatile disks(DVD), or other optical disk storage, magnetic cassettes, magnetic tape,magnetic disk storage, or other magnetic storage devices, or any othermedium which can be used to store the desired information and which canbe accessed by server 22. Communication media typically embodiescomputer readable instructions, data structures, program modules, orother data in a modulated data signal, such as a carrier wave or othertransport mechanism, and includes any information delivery media. Theterm “modulated data signal” means a signal that has one or more of itscharacteristics set or changed in such a manner as to encode informationin the signal. By way of example, and not limitation, communicationmedia includes wired media, such as a wired network or direct-wiredconnection, and wireless media such as acoustic, RF, infrared and otherwireless media. Combinations of any of the above should also be includedwithin the scope of computer readable media.

The computer storage media, including database cluster 24, discussedabove and illustrated in FIG. 1, provide storage of computer readableinstructions, data structures, program modules, and other data forserver 22.

Server 22 may operate in a computer network 26 using logical connectionsto one or more remote computers 28. Remote computers 28 can be locatedat a variety of locations in a medical or research environment, forexample, but not limited to, clinical laboratories, hospitals, otherinpatient settings, a clinician's office, ambulatory settings, medicalbilling and financial offices, hospital administration, veterinaryenvironment and home health care environment. Clinicians include, butare not limited to, the treating physician, specialists such assurgeons, radiologists and cardiologists, emergency medicaltechnologists, physician's assistants, nurse practitioners, nurses,nurse's aides, pharmacists, dieticians, microbiologists, laboratoryexperts, laboratory scientist, laboratory technologists, geneticcounselors, researchers, veterinarians and the like. The remotecomputers may also be physically located in non-traditional medical careenvironments so that the entire health care community is capable ofintegration on the network. Remote computers 28 may be a personalcomputer, server, router, a network PC, a peer device, other commonnetwork node or the like, and may include some or all of the elementsdescribed above relative to server 22. Computer network 26 may be alocal area network (LAN) and/or a wide area network (WAN), but may alsoinclude other networks. Such networking environments are commonplace inoffices, enterprise-wide computer networks, intranets and the Internet.When utilized in a WAN networking environment, server 22 may include amodem or other means for establishing communications over the WAN, suchas the Internet. In a networked environment, program modules or portionsthereof may be stored in server 22, or database cluster 24, or on any ofthe remote computers 28. For example, and not limitation, variousapplication programs may reside on the memory associated with any one orall of remote computers 28. It will be appreciated that the networkconnections shown are exemplary and other means of establishing acommunications link between the computers may be used.

A user may enter commands and information into server 22 or convey thecommands and information to the server 22 via remote computers 28through input devices, such as keyboards, pointing devices, commonlyreferred to as a mouse, trackball, or touch pad. Other input devices mayinclude a microphone, scanner, or the like. Server 22 and/or remotecomputers 28 may have any sort of display device, for instance, amonitor. In addition to a monitor, server 22 and/or computers 28 mayalso include other peripheral output devices, such as speakers andprinters.

Although many other internal components of server 22 and computers 28are not shown, those of ordinary skill in the art will appreciate thatsuch components and their interconnection are well known. Accordingly,additional details concerning the internal construction of server 22 andcomputer 28 need not be disclosed in connection with the presentinvention.

Although the method and system are described as being implemented in awindows operating system operating in conjunction with a LAN operatingsystem, one skilled in the art would recognize that the method andsystem can be implemented in any system.

With reference to FIG. 2, a method 200 in a computerized healthcareenvironment for configuring storing designations of orders in order setsis shown. At step 202, a request to build an order set is received. Adatabase is accessed and possible orders for the specified order set aredisplayed at step 204. A user may select orders from a list of possibleorders to construct an order set. Each order selected for the order setis designated as optional or required for the order set. The designationof a selected order is received at step 206 of FIG. 2. At step 208, itis determined whether the selected order has been designated as requiredfor the order set. If the order is required at step 210, the selectedorder is stored in a table or database as a required order for the orderset. An exemplary database is a relational database computer system inwhich orders for testing can be placed. Alternative databases couldinclude XML documents or an object oriented database integrated with aclinical information system.

If at step 208 it is determined that the selected order is not requiredfor the order set at step 212, it is determined whether the order hasbeen designated to be displayed to all users. An order designated to bedisplayed to all users may be activated by a caregiver placing the orderset. The order also may be displayed to a laboratory scientist ortechnologist after the order set has been placed. A technologist orscientist may activate optional orders not activated by the caregiverwhen the order set was originally placed based on laboratory findingsassociated with other orders in the set. In some instances, the presenceor absence of additional data available to the technologist that wasunavailable to the caregiver at the time the order set was placed may beused to determine if the optional orders should be activated.

If the order has been designated to be displayed to all users at step214, the order is stored as being an optional order that is displayed toall users of the system. If at decision step 212 it is determined thatthe order is not to be displayed to all users, at step 216 it is storedthat the order is to be displayed only after the order set is initiallyordered. For example, the order may be selected to be displayed asoptional after the order set has been placed so that a laboratoryscientist or technician can view the optional order but not displayed toa caregiver placing the initial order set. At step 218, it is determinedwhether there are any other orders for the order set to be designated tobe part of the order set. If so, at step 206 the selection anddesignation of another order for the order set is received.

For example, with reference to FIG. 6, the screen 600 displays buildingan order set for a healthcare environment. The order set is for a casetype HLX case red cell 602. The case type may also be organized intosample and specimen types such as amniotic fluid 606 or a blood 604. Forthe amniotic fluid 606 there are six possible orders for the HLX redcell 602 order set. The possible orders include an HLX-Duffy order 608,an HLX-RHCE order 610, an HLX-RHD pseudo gene order 612, an HLX-Kellorder 614, and HLX-RHD order 616 and a DNA isolation order 618. Inscreen 600, the HLX-RHD pseudo gene order 612 is designated as anoptional order for the order set to be displayed only after the initialorder set for the patient has been placed by selecting dropdown menuitem 620. As such, the order will only be displayed to a designatedlaboratory user fulfilling orders from the order set and not to thecaregiver placing the initial order set.

With reference to FIG. 7, a screen 700 is shown displaying possibleorders for the order set 602 for the case type HLX case red cell foramniotic fluid. In this example, the order HLX-Duffy 608 is designatedas an optional order for the order set to be displayed to all users byselecting dropdown menu item 720. Thus, the optional order of HLX-Duffywill be displayed as an optional order for the order set to all usersincluding the initial caregivers and laboratory users.

With reference to FIG. 8, a screen is shown for building the case typeHLX case red cell 602 for amniotic fluid. In this example, the DNAisolation order 618 is being designated as “not optional” by selectingdropdown menu item 820. Thus, the order of DNA isolation will beincluded in the order set, however, it will not capable of beingselected by a user. It will be required each and every time the orderset is placed.

With reference to FIG. 3, a method 300 for receiving the selection ofoptional orders from an order set and placing the optional orders isshown. At step 302, a request for an order set to be placed is receivedfrom a first user. The first user may be a caregiver responsible forplacing the initial order set for a patient. At step 304, a database isaccessed to determine the optional and required orders for the orderset. The accessed database may be built using the steps described inFIG. 2.

At step 306 of FIG. 3, optional orders to be displayed to all users aredisplayed. Specifically, the optional orders designated to be viewed byall users at step 214 of FIG. 2 are displayed to the user placing theinitial order set. The caregiver may be a healthcare provider, such as anurse or doctor. With reference to FIG. 9, a screen 900 displaying themanner in which optional orders may be activated is shown. In thisexample, optional orders for fictitious patient Jane Doe 902 aredisplayed. The optional orders from which a caregiver may choose in theHLX cell order set 904 are the HLX-Duffy 906 order, the HLX-RHCE order908, the HLX-Kell 912 order, and the HLX-RHD 914 order. These may bemanually selected by a user or may be designated as pre-selectedoptional orders for that type of order set.

Referring again to FIG. 3, at step 308 selection(s) of optional ordersto be placed by the user are received. Referring again to FIG. 9, inthis example a user has selected the HLX-RHCE order 910 and HLX-RHDorder 914 to be placed for the order set. The HLX-Duffy order 908 andthe HLX-Kell order 912 are not selected from the list of optional ordersand will not be placed.

Referring again to FIG. 3, at step 310 the selected optional orders areplaced for the order set for the patient. At step 312, the orders thatwere designated as required are also placed for the order set for thepatient.

With reference to FIG. 4, a method 400 for displaying optional ordersafter the order set has been placed is shown. At step 402, a request isreceived for an order set after the order set has been previouslyplaced. In one embodiment, a second user, such as a laboratory scientistor technologist fulfilling laboratory orders, requests to view the orderset placed. At step 404, the orders placed for the order set aredetermined. A database or table that includes the orders placed for theorder set for the patient is accessed. The database or table includesthe optional orders selected by the first user. At step 406, it isdetermined which optional orders for the order set were not selected bya first user. Again, this information may be contained in a database ortable.

At step 408, optional orders for the order set that were designated tobe displayed only after the initial order set is placed are determined.At step 410, orders placed for the initial order set placed aredisplayed. These may be laboratory orders placed and to be fulfilled. Atstep 412, optional orders that were not initially placed for the orderset are displayed and may be selected. Also at step 412, optional ordersonly to be displayed after the initial order set is placed aredisplayed. At step 414, the selection of optional orders to be placed isreceived. For example, a second user such as a laboratory technologistor scientist may select the optional orders to be placed. At step 416,the optional orders selected are placed for the order set.

With reference to FIG. 5, a block diagram 500 displaying an exemplaryoptional order set 502 is shown. The optional order set 502 includesORDER 1, ORDER 2, ORDER 3 and ORDER 4. ORDERS 1, 2 and 3 are designatedto be displayed to all users. ORDER 4 is designated to be displayed onlyafter the initial order set is placed. As such, optional orders 1, 2 and3 are displayed to the first user 504 who is placing the initial orderset.

The first user 504 has selected optional order 1 to be placed. As such,order 1 is displayed to the second user 506 as having been placed by thefirst user 504. As the initial order set has been placed by user 1,ORDERS 2 and 3 are displayed as optional to user 2 orders because ORDERS2 and 3 were not placed by user 1. Optional order 4 is only displayed touser 2 as the initial order set has been placed by user 1. While thisexample expressed as having different users, it is possible that asingle user who places the order may see different options depending onthe point in the clinical process.

Referring next to FIG. 10, an exemplary screen 1000 displaying activatedand non-activated optional orders is shown. In this example, the screenis displayed to a second user, such as a laboratory scientist ortechnologist. The screen includes the order set list 1004 for fictitiouspatient Jane Doe 1002. As can be seen in the order set list 1004,optional orders HLX RHCE 1008 and HLX-RHE 1014 were selected and placedby a first user. The status of optional orders 1008 and 1014 is that theorders are in the laboratory awaiting completion. The required order forDNA Isolation 1016 has also been placed for the order set for thepatient.

Optional orders HLX-Duffy 1006 and HLX-Kell 1012 were displayed to afirst user in FIG. 9, but were not selected and placed. As such, theseoptional orders may still be selected and placed by the second user.These optional orders may also be selected and placed by any other userwith appropriate access and authorization. The optional order HLXRHD-Pseudogene 1010 has been designated to be displayed only to thesecond user, such as a laboratory scientist of technologist. As such,optional order 1010 was not displayed to the first user as shown in FIG.9. Optional order 1010 is shown as being selected and activated by thesecond user.

Referring next to FIG. 11, a screen 1100 displaying activated andnon-activated optional orders is shown. In this example, the screenshows optional orders for an orders set activated by either a first andsecond user, and required orders activated for the order set that arefor fictitious patient Jane Doe 1002. However, in FIG. 10, optionalorder 1010 selected and activated by a second user in FIG. 11 is shownas having been placed and in the laboratory for completion.

By way of example, an order set may be for testing red cell antigen genesystems within a molecular diagnostic laboratory. The specific red cellantigen gene systems that can be tested for are RH C, RH D, Kell, RHDPseudogene and Duffy. The actual gene system(s) that needs to be testedis dependent on the particular patient being tested. Thus, an order sethas been built such that the red cell antigen gene system orders areoptional orders within the order set. When the order set is selected, auser is prompted to identify which optional orders should be includedwhen the order set is placed. The selected optional orders are activatedand the order set is placed in the system. After the order set has beenplaced, during the clinical analysis of a case, a user may determinethat activating an optional order not previously activated isappropriate. The user may right click on the representation of theorder, select “activate order” and the order becomes active triggeringrelated billing and workload events triggered within the system.

The present invention has been described in relation to particularembodiments, which are intended in all respects to illustrate ratherthan restrict. Alternative embodiments will become apparent to thoseskilled in the art that do not depart from its scope. Many alternativeembodiments exist, but are not included because of the nature of thisinvention. A skilled programmer may develop alternative means forimplementing the aforementioned improvements without departing from thescope of the present invention.

It will be understood that certain features and sub-combinations ofutility may be employed without reference to features andsub-combinations and are contemplated within the scope of the claims.Furthermore, the steps performed need not be performed in the orderdescribed.

The invention claimed is:
 1. A method in a computerized environment thatimproves managing and activating orders and related events based on anoccurrence of a required event in a sequence of events and a designationof each of a plurality of optional healthcare orders in the database,the method comprising: receiving a request to build a generic order set;building the generic order set, comprising; accessing possible ordersand displaying the possible orders to a user, the possible orders beingselectable; receiving, from the user, selected orders from a list ofpossible orders, the selection of orders comprising an indication thateach of the selected orders is to be required or is to be optional, theselection of optional orders comprising an indication that each of theselected optional orders is to be displayed to all users or not to bedisplayed to all users, the selection of required orders and selectedoptional orders comprising the generic order set; and storing thegeneric order set; receiving a request to build a patient-specific orderset; building the patient-specific order set, comprising: accessing thegeneric order set, the generic order set comprising a plurality ofrequired orders, a first optional order, and a second optional order;receiving an indication that the first optional order of the genericorder set is viewable by any user and displaying the first optionalorder to a first user at a time when the first user is building thepatient-specific order set, the first optional order being selectable;receiving an indication that the second optional order of the genericorder set is not to be displayed to all users at the time the first useris building the patient-specific order set and not displaying the secondoptional order until after the first user completes building thepatient-specific order set and after the patient-specific order set isplaced; receiving a request to place the patient-specific order set, thepatient-specific order set comprising the plurality of required ordersand an indication of whether the first optional order is selected;placing, in response to receiving the request to place thepatient-specific order set, the patient-specific order set, whereinplacing the patient-specific order set comprises; (1) the server placingthe first optional order and the plurality of required orders in aworkflow, (2) the server activating within the system clinical eventsrelated to the orders placed, and (3) the server tracking a status ofthe orders placed; subsequent to the patient-specific order beingplaced, displaying the second optional order to the second user, whereinthe second optional order is selectable to be placed by the second user.2. The method of claim 1, wherein the first user is a healthcareprovider.
 3. The method of claim 1, wherein the request to place thefirst optional order for the patient-specific order set is not received.4. The method of claim 3, further comprising: displaying the firstoptional order to a second user after the patient-specific order set hasbeen placed.
 5. The method of claim 1, wherein the second optional orderis displayed to the second user.
 6. The method of claim 5, wherein thesecond optional order is not displayed to the first user.
 7. The methodof claim 5, wherein the second user is a laboratory technologist.
 8. Themethod of claim 5, further comprising: receiving a request to place thesecond optional order for the patient-specific order set by the seconduser.
 9. The method of claim 1, wherein the patient-specific order setfurther comprises one or more orders to be automatically placed when theorder set is placed.
 10. The method of claim 1, wherein thepatient-specific order set comprises other optional orders in additionto the first and second optional orders, the other optional orders beingselectable.
 11. A method in a computerized environment that improvesmanaging and activating a healthcare order set and related events bydisplaying to a display device one or more optional healthcare ordersthat are potentially necessary based on the occurrence of a requiredevent in a sequence of events and a designation of each of the optionalhealthcare order in the database, the method comprising: accessing apatient-specific order set after the patient-specific order set has beenplaced, the patient-specific order set comprising one or more ordersincluding a plurality of required orders as well as a first optionalorder, and a second optional order; receiving an indication that thefirst optional order of the patient-specific order set is viewable byany user and displaying the first optional order to a first user at atime when the first user is building the patient-specific order set, thefirst optional order being selectable; receiving an indication that thesecond optional order of the patient-specific order set is not to bedisplayed to all users and not displaying the second optional order atthe time when the first user is building the patient-specific order set;receiving an indication that optional orders for the patient-specificorder set that have not been placed for the order set; displaying to asecond user, optional orders for the patient-specific order set that aredetermined to have not been placed for the patient-specific order setand the second optional order for the patient-specific order setdetermined to have been designated to be displayed after thepatient-specific order set is placed, wherein the second optional orderfor the patient-specific order set that is designated to be displayedafter the patient-specific order set is placed is being displayed onlyafter the required orders have been placed, the second optional orderbeing selectable; receiving a request to place the second optionalorder; placing, in response to receiving the request to place the secondoptional order, the second optional order, wherein placing the secondoptional order comprises; (1) the server placing the first optionalorder and the plurality of required orders in a workflow, (2) the serveractivating within the system clinical events related to the ordersplaced, and (3) the server tracking a status of the orders placed; andplacing by the server over the computer network the selection ofdisplayed optional orders for the order set establishing a formalpresence of the selected optional orders for the order set in a workflowtriggering within the system related billing and workload events relatedto the required and selected optional orders.
 12. The method of claim11, wherein the patient-specific order set is placed by a first user.13. The method of claim 11, wherein the first and second user may or maynot be the same.
 14. The method of claim 11, wherein the second user isa laboratory technologist.
 15. The method of claim 11, wherein thepatient-specific order set further comprises one or more orders to beautomatically placed when the order set is placed.